Ominous Etiology of Blurry Vision

An elderly woman with cell lung squamous cell carcinoma presented with blurry vision. Examination revealed left homonymous hemianopia, and magnetic resonance imaging (MRI) demonstrated a right occipital and small bihemispheric infarcts (Figure 1A and B). Fluid-attenuated inversion recovery study raised suspicion of an underlying left occipital mass (Figure 1C) confirmed by contrasted MRI (Figure 1D). Magnetic resonance angiography revealed a flow-limiting stenosis of the right P2 branch of the posterior cerebral artery (Figure 2A). Echocardiogram showed a nefarious mobile mass extending into the left atrium (Figure 2B). Initially suspected to be a thrombus, a positron emission tomography scan revealed a hypermetabolic lung mass extending into the left pulmonary vein (Figure 2C-coronal and D-axial)